Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Health Care Industry. Show all posts
Showing posts with label Health Care Industry. Show all posts

Thursday, July 11, 2019

The Business of Health Care Depends on Exploiting Doctors and Nurses

Danielle Ofri
The New York Times
Originally published June 8, 2019

One resource seems infinite and free: the professionalism of caregivers.

You are at your daughter’s recital and you get a call that your elderly patient’s son needs to talk to you urgently.  A colleague has a family emergency and the hospital needs you to work a double shift.  Your patient’s M.R.I. isn’t covered and the only option is for you to call the insurance company and argue it out.  You’re only allotted 15 minutes for a visit, but your patient’s medical needs require 45.

These quandaries are standard issue for doctors and nurses.  Luckily, the response is usually standard issue as well: An overwhelming majority do the right thing for their patients, even at a high personal cost.

It is true that health care has become corporatized to an almost unrecognizable degree.  But it is also true that most clinicians remain committed to the ethics that brought them into the field in the first place.  This makes the hospital an inspiring place to work.

Increasingly, though, I’ve come to the uncomfortable realization that this ethic that I hold so dear is being cynically manipulated.

By now, corporate medicine has milked just about all the “efficiency” it can out of the system.  With mergers and streamlining, it has pushed the productivity numbers about as far as they can go.

But one resource that seems endless — and free — is the professional ethic of medical staff members.

This ethic holds the entire enterprise together.  If doctors and nurses clocked out when their paid hours were finished, the effect on patients would be calamitous.  Doctors and nurses know this, which is why they don’t shirk.  The system knows it, too, and takes advantage.

The demands on medical professionals have escalated relentlessly in the past few decades, without a commensurate expansion of time and resources.  For starters, patients are sicker these days.  The medical complexity per patient — the number and severity of chronic conditions — has steadily increased, meaning that medical encounters are becoming ever more involved.  They typically include more illnesses to treat, more medications to administer, more complications to handle — all in the same-length office or hospital visit.

The information is here.

Wednesday, November 25, 2015

Americans With Government Health Plans Most Satisfied

by Rebecca Riffkin
Gallup
Originally published November 6, 2015

Americans' satisfaction with the way the healthcare system works for them varies by the type of insurance they have. Satisfaction is highest among those with veterans or military health insurance, Medicare and Medicaid, and is lower among those with employer-paid and self-paid insurance. Americans with no health insurance are least satisfied of all.

STORY HIGHLIGHTS

  • Uninsured Americans least satisfied with health system
  • Those with veterans or military insurance most satisfied
  • Self-insured less satisfied than others who have insurance

Sunday, October 4, 2015

Merge Away!!!

By Art Caplan
The Health Care Blog
Originally posted September 14, 2015

Here is an excerpt:

The Times and every other commentator who has weighed in including the AMA has warned that diminished competition is not good for taxpayers or consumers. They want the Justice Department to take a long hard look at these latest mergers to insure that consumers are not stuck with higher premium costs as many parts of the country turn into markets with only one insurance provider.

The critics are wrong. Blocking these deals is a terrible idea. The mergers should be allowed to continue. In fact they should proceed until there is only one private insurer left. Only, at that point should the government step in, declare the last company standing to be required to merge with Medicare thereby letting the free market produce what many reformers have only been able to dream of—a single payer system.

The entire article is here.

Wednesday, June 17, 2015

“Should I feel badly that I acted unethically?”

By Craig Klugman
bioethics.net
Originally posted May 29, 2015

Here is an excerpt:

At the base of this whole scenario is the concept that medicine is a business and businesses need to know what their competitors are doing. Unethical businesses try to increase market share not by producing a better product or service, but by undermining their competition. Aside from the medical ethics issues in this case, there is a very basic business ethics concern: Do not harm another to further your own interest. One of the most important professional values in medicine is altruism—that your choices and behaviors are for the benefit of another, not yourself. Roger loses sight of that when he only sees a problem when he feels personally threatened. Altruism is a basic component of a profession. Medicine is a profession. Business is not. Thus, in this situation the values of medicine and the values of business collide.

The corporatization of medicine as a center of profit has lost sight of the goal, which is to help people in need. That a non-medical professional would open a clinic “as a side business” is disturbing. Medicine should not be a way for one to achieve wealth, but rather be a way to be a servant to the community. Business ethics should always come second to medical ethics in a healing environment.

The entire article is here.

Wednesday, May 20, 2015

How is the doctor-patient relationship changing? It’s going electronic.

By Suzanne Allard Levingston
The Washington Post
Originally posted April 27, 2015

Here are two excerpts:

Almost three-quarters of American adults use the Internet to search online for health information each year, according to the Pew Research Center. While patients are digging through new information, so are doctors. A “tsunami of knowledge” from hundreds of journals pours over doctors, says Jack Cochran, executive director of the Permanente Federation.

All this information changes the culture. “Doctors say they’re taught to know things that others don’t,” said Dave deBronkart, a cancer survivor and advocate for patient engagement. Today, thanks to online searches and communities, a patient may know about advances before a doctor does.

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Not only should you read your electronic health record, you should check for errors. “Most people’s records contain mistakes,” deBronkart said. His 2009 blog about mistakes in his Google Health record led to a front-page story in the Boston Globe and a career as an advocate known as e-Patient Dave. (Google Health, a free service intended to help consumers pull together medical and wellness information, was discontinued in 2013 because it failed to generate broad interest.)

The entire article is here.

Tuesday, January 20, 2015

Dilemma over deductibles: Costs crippling middle class

By Laura Ungarand Jayne O'Donnell
The Battle Creek Enquirer
Originally published January 2, 2015

Here are two excerpts:

A recent Commonwealth Fund survey found that four in 10 working-age adults skipped some kind of care because of cost. The portion of workers with annual deductibles — what consumers must pay before insurance kicks in — rose from 55% eight years ago to 80% today, according to research by the Kaiser Family Foundation.

A Mercer study showed that 2014 saw the largest one-year increase in enrollment in “high-deductible plans” — from 18% to 23% of all covered employees.

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Doctors and doctor groups say such individual coping strategies can be helpful, but action is needed on a national level. The American Academy of Pediatrics recently came out with a policy statement saying high-deductible plans “may be a less desirable way to lower health care costs than other means … even if ‘other means’ require more work by government, insurance companies and other health policy participants.”

The entire story is here.

Tuesday, November 4, 2014

Doctors Tell All—and It’s Bad

By Meghan O'Rourke
The Atlantic
Originally published October 14, 2014

Here is an excerpt:

But this essay isn’t about how I was right and my doctors were wrong. It’s about why it has become so difficult for so many doctors and patients to communicate with each other. Ours is a technologically proficient but emotionally deficient and inconsistent medical system that is best at treating acute, not chronic, problems: for every instance of expert treatment, skilled surgery, or innovative problem-solving, there are countless cases of substandard care, overlooked diagnoses, bureaucratic bungling, and even outright antagonism between doctor and patient. For a system that invokes “patient-centered care” as a mantra, modern medicine is startlingly inattentive—at times actively indifferent—to patients’ needs.

To my surprise, I’ve now learned that patients aren’t alone in feeling that doctors are failing them. Behind the scenes, many doctors feel the same way. And now some of them are telling their side of the story. A recent crop of books offers a fascinating and disturbing ethnography of the opaque land of medicine, told by participant-observers wearing lab coats. What’s going on is more dysfunctional than I imagined in my worst moments. Although we’re all aware of pervasive health-care problems and the coming shortage of general practitioners, few of us have a clear idea of how truly disillusioned many doctors are with a system that has shifted profoundly over the past four decades. These inside accounts should be compulsory reading for doctors, patients, and legislators alike. They reveal a crisis rooted not just in rising costs but in the very meaning and structure of care. Even the most frustrated patient will come away with respect for how difficult doctors’ work is. She may also emerge, as I did, pledging (in vain) that she will never again go to a doctor or a hospital.

The entire article is here.

Saturday, January 11, 2014

The Healthcare Industry and the U.S.S.R.

By Jeanne Pinder
Ignite: Enlighten us, but make it quick
Uploaded December 16, 2013


Why 'Cherry-Picking' Patients Is Gaining Ground

By Leigh Page
Medscape - Psychiatry
Originally published December 19, 2013

Lower reimbursements, busier practices, and the rise of outcomes-based payments are inciting more physicians to think about cherry-picking -- that is, selecting patients with better payments or fewer health problems. Many physicians admit they do it, although they may feel guilty about it, or they worry that being too aggressive in this realm could harm their practices and standing.

Health insurers have been well known for cherry-picking members, although new regulations have eliminated some of those behaviors. But physicians do some cherry-picking, too, said Jim Bailey, MD, a professor of internal medicine at the University of Tennessee Health Science Center in Memphis, who has written about the phenomenon. If you choose a higher-paying specialty or locate your offices in an affluent suburb, cherry-picking can be a factor in keeping your practice profitable, he said.

The entire article is here.

This article comes in four parts.  You will need to click through in order to read the entire article.